As The Hospital Pervs

sweepthefloor said:

I won't put your heart in a chemical jar. I like hearts and all, I prefer them beating.

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It's alright.

I'd just be happy if it meant something to someone.

OMFG! Laughing my ass off over here! Respiratory, STAT! We need a breathing treatment!

That's one hell of a slow gtt gtt gtt when you're waiting on the Leave-em-dead, I mean Levophed, too, isn't it?

BeachMomma said:

Between 4 and 5. That's the goal.

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Yes! And torsades does look ugly! I think it is rare anyway, but the risk is still there! Haldol IV also prolongs the QT interval.

Things you won't hear in a telemetry nurse to nurse report: Regular Sinus Rhythm with no ectopy! Hahahahaha that would be the funniest.

Byron In Exile said:

It's alright.

I'd just be happy if it meant something to someone.

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Some things always means some thing to someone. There is always a rationale.

sweepthefloor said:

Yes! And torsades does look ugly! I think it is rare anyway, but the risk is still there! Haldol IV also prolongs the QT interval.

Things you won't hear in a telemetry nurse to nurse report: Regular Sinus Rhythm with no ectopy! Hahahahaha that would be the funniest.

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Sure ya do! I hear it all the time! Hell, I bet 10% of our patients aren't even on the monitor!

The question remains - and we ask it daily - what the FUCK are those patients doing taking up our beds and tele space?

When we get a reasonable answer, I'll share it with you.

BeachMomma said:

OMFG! Laughing my ass off over here! Respiratory, STAT! We need a breathing treatment!

That's one hell of a slow gtt gtt gtt when you're waiting on the Leave-em-dead, I mean Levophed, too, isn't it?

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Me too! Oh yes, STAT respiratory. BTW, that cute RT is married. I noticed his wedding band. Oh well.

Lev-O-Dead, stuff is nasty but it works. Hey, it could be worse than levo! It could be: maxed out on 3 pressors (stressors), and that's when you switch to 1:1 nursing. Or, the PH is 6.9 and my hand hurts from pushing amps of HCO3.

I LOVE BICARB! I am not sure how it works. I will have to go back to chemistry for that answer but for some reason: when the patient is acidotic and the drugs aren't working, and we start dumping in the bicarbonate, the medications start working again!

My mentor used to tell me: I got your Love-A-Phed drip right here, you want it wide open? Oh yes please.

sweepthefloor said:

Some things always means some thing to someone. There is always a rationale.

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That's a comforting thought.

BeachMomma said:

Sure ya do! I hear it all the time! Hell, I bet 10% of our patients aren't even on the monitor!

The question remains - and we ask it daily - what the FUCK are those patients doing taking up our beds and tele space?

When we get a reasonable answer, I'll share it with you.

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Well how about when you get a transfer into a telemetry bed just for Haldol IV? They used to do that to us all the time.

Not on the monitor! How about when you get report that the patient is sinus tachycardia when really it's a rapid A fib! Huh? Say what?

I got so tired of saying: Rapid A Fib, I started making up new names: The patient is in a fast atrial fibrillation. The patient is in atrial fibrillation with quick ventricular response!

It is an atrial fibrillation with a ventricular trying to play catch up rate.

Hehehehe

sweepthefloor said:

Me too! Oh yes, STAT respiratory. BTW, that cute RT is married. I noticed his wedding band. Oh well.

Lev-O-Dead, stuff is nasty but it works. Hey, it could be worse than levo! It could be: maxed out on 3 pressors (stressors), and that's when you switch to 1:1 nursing. Or, the PH is 6.9 and my hand hurts from pushing amps of HCO3.

I LOVE BICARB! I am not sure how it works. I will have to go back to chemistry for that answer but for some reason: when the patient is acidotic and the drugs aren't working, and we start dumping in the bicarbonate, the medications start working again!

My mentor used to tell me: I got your Love-A-Phed drip right here, you want it wide open? Oh yes please.

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Janey, I just love you!

It's the RT's loss. Our RT is married too. I wouldn't do him, but I love bantering with him and admiring the view. Is it an admission requirement for respiratory programs that they be cute? It must be.

Yeah, there are things worse than Levo; I don't have to worry about them. Yet. I always <sarcasm> loved </sarcasm> doing bedside surgical procedures on pts with a Levo gtt running. That always makes the CRNA just a little more nervous than usual. OK, a lot more nervous. They just wanted us to hurry up, do what we had to do, and get that scope the hell out of there so they could wake the patient up again. When anesthesia is nervous, they tend to pass that on. We like anesthesia to be happy; when anesthesia is happy, EVERYBODY is happy.

I haven't had to push HCO3 yet. I've given a lot of HCO3 gtts, but I haven't pushed it yet.

Byron In Exile said:

That's a comforting thought.

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We are all about the comfort at this popsicle stand, but if it's gonna hurt we will let you know in advance.

We know when it's going to hurt, and we tell the truth about it.

sweepthefloor said:

Well how about when you get a transfer into a telemetry bed just for Haldol IV? They used to do that to us all the time.

Not on the monitor! How about when you get report that the patient is sinus tachycardia when really it's a rapid A fib! Huh? Say what?

I got so tired of saying: Rapid A Fib, I started making up new names: The patient is in a fast atrial fibrillation. The patient is in atrial fibrillation with quick ventricular response!

It is an atrial fibrillation with a ventricular trying to play catch up rate.

Hehehehe

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I haven't had the honor of the IV Haldol situation - yet. We get everybody who's ever had any kind of cardiac issue at all - psych, ortho, neuro, anything - even OB. The cardiac issue might be stable and the patient has cardiac clearance, but tele is just a dumping ground.

To be fair, it can be a little hard to differentiate between uncontrolled A fib and ST. I'm a stickler for details; I'll stand there and stare at the monitor for a while to watch for irregular heartbeats. If it's really A fib, I'll usually catch it.

Ventricular catch up. Nice. LOL

BeachMomma said:

Janey, I just love you!

It's the RT's loss. Our RT is married too. I wouldn't do him, but I love bantering with him and admiring the view. Is it an admission requirement for respiratory programs that they be cute? It must be.

Yeah, there are things worse than Levo; I don't have to worry about them. Yet. I always <sarcasm> loved </sarcasm> doing bedside surgical procedures on pts with a Levo gtt running. That always makes the CRNA just a little more nervous than usual. OK, a lot more nervous. They just wanted us to hurry up, do what we had to do, and get that scope the hell out of there so they could wake the patient up again. When anesthesia is nervous, they tend to pass that on. We like anesthesia to be happy; when anesthesia is happy, EVERYBODY is happy.

I haven't had to push HCO3 yet. I've given a lot of HCO3 gtts, but I haven't pushed it yet.

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womp womp! love me love me. I got your back, come to ICU! I won't let them haze you so bad. Orientation was a pretty humbling experience for me. My nurse manager said to me: These nurses are strong, and they will make you strong.

The RTs... we have so many, and they look so cool the way they walk around like they own the joint. It's a good relationship. I learn a lot from them. The first thing I learned in ICU the RT said to me: The doctor wants the PEEP higher, watch your blood pressure go down. It was true! Something about the thoracic pressure and the heart blah blah blah.

Yeah, once you start pushing that HCO3 they better be in the unit because they are going to code.

Tell anesthesia to give us some vapor! I don't know why but when we do Minor OR at the bedside anesthesia never shows up for us. WTF? I guess cause the patients are usually sedated and ventilated already? At least the Minor staff comes to us cause I don't know how to use those scopes lol

I don't like letting my patients off the unit to go to Minor. The last time I did anesthesia called and said: Get your room ready we are going to intubate and do the upper GI in the room. The bottom line: They didn't want to recover the patient.

BeachMomma said:

I haven't had the honor of the IV Haldol situation - yet. We get everybody who's ever had any kind of cardiac issue at all - psych, ortho, neuro, anything - even OB. The cardiac issue might be stable and the patient has cardiac clearance, but tele is just a dumping ground.

To be fair, it can be a little hard to differentiate between uncontrolled A fib and ST. I'm a stickler for details; I'll stand there and stare at the monitor for a while to watch for irregular heartbeats. If it's really A fib, I'll usually catch it.

Ventricular catch up. Nice. LOL

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I do a lot of ortho in trauma now but one time on telemetry a little old lady with a broken hip was sent to our floor for cardiac history and clearance pre-operative. I freaked out cause the orders read: Bucks Traction!

I freaked! I called the ortho floor and the nurse came down and set it up. It wasn't so bad, and it even relieved some pain.

It's not a dumping ground it's just that all Attendings know that on telemetry the patient will be seen frequently, so they will use any excuse to get their patient on a telemetry bed.

Yeah if it's really fast it's hard to tell the difference, but if it's that fast well hell...

ehhh, Let them haze. I ain't skeered. Seriously, I look at it like this. If I screw up something and somebody tells me nicely and politely, I might remember for all of 5 seconds - if I'm lucky. If they rant and rave and chew my ass, I'll never forget it. I might hate that nurse or MD now, but I'll appreciate it when the situation arises again, and I can SEE and HEAR that nurse or MD yelling in my mind's eye. Those are the lessons you don't forget in a hurry.

The only time I've seen HCO3 pushed, I was doing my preceptorship in ICU. We also had a paramedic student. They let him push it. Dammit. I actually pouted. LOL

I'm not sure who Minor staff is (lol), but every place I've ever worked at, anesthesia accompanies us to the bedside. Anesthesia should *never* have to recover the patient. That's why we have PACU. I have to wonder if they got a good look at the labs and said fuck this shit - especially for an EGD. We don't like transporting pts when their H&H's look like they have one red cell left in their body. Hell, I used to make that call. I'd check on a GIB's H&H and ask if we could do it bedside. And NOBODY hated bedside procedures more than I. If that GIB turns out to be a ruptured esophageal varix, things get ugly real fast. We've flown a patient out from the procedure room because a varix ruptured. I doubt that he made it to the trauma center though. I've never seen so much red in my life. He was pouring it out faster than we could suck it out or pump more back in.

sweepthefloor said:

I do a lot of ortho in trauma now but one time on telemetry a little old lady with a broken hip was sent to our floor for cardiac history and clearance pre-operative. I freaked out cause the orders read: Bucks Traction!

I freaked! I called the ortho floor and the nurse came down and set it up. It wasn't so bad, and it even relieved some pain.

It's not a dumping ground it's just that all Attendings know that on telemetry the patient will be seen frequently, so they will use any excuse to get their patient on a telemetry bed.

Yeah if it's really fast it's hard to tell the difference, but if it's that fast well hell...

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I've heard of Bucks Traction, but if I had an order to set it up.... LOL

OK, if you put it that way, I don't mind so much being the dumping ground. I still mind but not as much. I'm sure that's it, but damn. We're already drowning here, and the supervisor is on the phone wanting empty beds for ER patients. We're seriously going to start putting pts in the hallway! WTF?

I had one the other day - uncontrolled A fib at 170. Well, it wasn't my pt. I made the mistake of answering the tele phone. I really have to quit doing that. Found the RN and passed along the message. She grinned and said, "Yeah, that's why he's on an Amio gtt." I wanted to smack the damn tele guy.

Ah don't worry, you will push amp after amp once you come to ICU. Then you'll be like so happy when the first year Resident wants to push it, cause your hand is cramping.

I guess it's a lot of work to go bedside. We call them the Minor OR-- you know the place where they do the bronchs, upper gi, TEE, and those kinds of procedures. If the patient is vented, they usually come to us. At bedside we are the PACU LOL.

It's easier for them to come to ICU, get it done and leave. If there is a problem they are still able to be out, we are the trauma unit and major OR is very close.

The bleeders! We have massive transfusion protocols and even an awesome rapid infuser. The blood bank will send us all the product at once in a cooler. It's pretty wild.

I was so scared at first giving so much product even just a few units. One time I had a unit going in at 125ml/hour, the usual. The trauma surgeon told me: It's a transfusion not an infusion. Take it off the pump and get a pressure bag on it.
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Yeah, I know what you mean about the ever lasting effects of degradation! Those night nurses made me cry, but I won't forget. It keeps us accountable, and we learn.

Shocking News! I also think the Attending gets more money for the care delivered on a telemetry bed. I can't be 100% sure about that, but I am 99% sure it must cost more money.

The anxiety of musical telemetry beds. We don't have a real 'tele command' center. The tele techs are on the floor so they know what's going on. In the unit there is no tele tech because we don't leave bedside. And guess what? We are bad bad nurses, most of the time we don't even sign our strips or calculate any intervals!

sweepthefloor said:

Ah don't worry, you will push amp after amp once you come to ICU. Then you'll be like so happy when the first year Resident wants to push it, cause your hand is cramping.

I guess it's a lot of work to go bedside. We call them the Minor OR-- you know the place where they do the bronchs, upper gi, TEE, and those kinds of procedures. If the patient is vented, they usually come to us. At bedside we are the PACU LOL.

It's easier for them to come to ICU, get it done and leave. If there is a problem they are still able to be out, we are the trauma unit and major OR is very close.

The bleeders! We have massive transfusion protocols and even an awesome rapid infuser. The blood bank will send us all the product at once in a cooler. It's pretty wild.

I was so scared at first giving so much product even just a few units. One time I had a unit going in at 125ml/hour, the usual. The trauma surgeon told me: It's a transfusion not an infusion. Take it off the pump and get a pressure bag on it.
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Yeah, I know what you mean about the ever lasting effects of degradation! Those night nurses made me cry, but I won't forget. It keeps us accountable, and we learn.

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Ohhhh! That's where I used to work. LOL I've just never heard them called Minors before.

I wouldn't know how to act if I could give rapid transfusion. They do it all the time in OR/endo, but I've never gone higher than 125-150mL/hr. It would probably scare the shit out of me too!

Our RT makes a great hand warmer.

"I was sitting on my porch and realized that I was shot in the neck."

He walked in with his finger in a bleeding hole, was taken to the OR, and woke up in an ICU bed.

I just opened the supply closet and 100 new enema bags fell out.

Who ordered that many?

Why are they in the Triage unit anyway, they should be on the Geriatrics floor.

Have fun with that!

Medical poet of the week: Surgeon writes:

"Permission to transfuse blood products in the setting of fevers."

I finally achieved the impossible. I almost strangulated myself - with my own damned stethoscope. I would love to say my coworkers dropped everything to rescue me, but alas, that was not how it happened. I'm pretty sure two RNs peed their scrubs today from laughing so hard. The wenches didn't even ask if I was ok!

OK, I gotta admit; I laughed till I cried too. It was pretty funny.

Amazing thread for a blood banker